Po-05-107 safety and long-term efficacy of intraoperative implantation of a leadless pacemaker

Permanent pacemaker implantation is not uncommon following valve surgery, but transvalvular, transvenous leads have the potential to negatively impact tricuspid valve function. Leadless cardiac pacemakers (LCP) are an attractive alternative for the management of bradyarrhythmias occurring post-valve surgery. We sought to assess the safety and long-term efficacy of implantation of LCPs during valve surgery, under direct visualization, in patients who had pre-existing indications for permanent pacing or were deemed at high risk for developing a post-op pacing indication. This is a single-center retrospective analysis of patients who underwent valve surgery and were implanted with a LCP (Micra, Medtronic Inc) under direct visualization during surgery. Long-term safety and pacemaker performance were analyzed. An acceptable pacing parameter (APP) was defined as a pacing capture threshold <2.0 V @ 0.24 ms, and an increase of no more than 1.5 V from implantation through follow-up . Between 12/2018 and 6/2022, 72 patients underwent LCP implantation under direct visualization during valve surgery. The mean age was 66.8 years and 55.6% were male. Multi-valve surgery was performed in 79.2% (n= 57), with nearly all patients receiving tricuspid valve surgery (n = 71, 98.6%). LCP implantation was successful in all 72 (100%) patients, with no device-related complications. Five patients (6.9%) died prior to discharge, of non-device related illness. At 1-month and 6-month follow-up, 96.1% and 94.4% of patients, respectively, had acceptable pacing parameters. For those patients reaching >1 year follow-up (n=28), 92.9% had acceptable pacing parameters. Intraoperative implantation of LCPs during valve surgery minimizes implant-related complications and results in highly effective electrical performance.